1,731 Grafts at Trichogenics – 12 Months Later: No Visible Improvement and Serious Concerns About What Was Agreed vs. What Was Delivered

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Bottom line up front​

I had 1,731 FUE grafts transplanted at Trichogenics in Thessaloniki in August 2025, including 308 beard grafts. The procedure was intended to address poor density following a previous transplant. I chose Trichogenics largely because of its doctor-led DHI approach and because Dr. Christos Tsakalos, who was formerly Trichogenics' Medical Director and Chief Surgeon, was supposed to lead and supervise the procedure.

The reality was quite different from what I had expected.

Dr. Chris was barely involved in the actual surgery. Significantly fewer grafts were harvested than I had understood from our preoperative discussions. The advertised surgical AI method, the Trivellini Mamba extraction device, and the HypoThermosol graft-holding solution were not used. I also experienced substantial pain during much of the implantation because of difficulties with anaesthesia, and a smaller recipient area was treated than originally planned.

Most importantly, 12 months later, I can see essentially no cosmetic improvement compared with my preoperative situation. The treated area, particularly on the left side, remains visibly see-through under normal everyday conditions.

I have remained in regular contact with Trichogenics throughout the postoperative period and have sent monthly progress pictures. Dr. Eric Peretz of Trichogenics was unable to identify a specific reason for the apparently poor result. I subsequently consulted a dermatologist and underwent a scalp examination and biopsy. The only diagnosis was androgenetic alopecia.

I have now formally requested a full refund.

Why I Chose Trichogenics​

This was my second transplant.

My first FUE procedure gave me a hairline and improved my appearance, but the yield was poor, and I felt that my donor area had been managed badly. Other doctors subsequently described my donor area as overharvested.

I was left with relatively low density and had to rely heavily on styling and slicked-back hairstyles. Some readers may be familiar with my case, as it was one of several that eventually contributed to Dr. Yaman being removed from the Hair Restoration Network's recommendations.

For my second transplant, I had independent consultations with Dr. Asi and Dr. Eric Peretz, starting in December 2024. I liked their emphasis on conservative donor management, medication, and physician involvement. Their advertised doctor-performed DHI approach also appealed to me.

I was particularly interested in having Dr. Chris Tsakalos involved. His focus on doctor-performed DHI and his published results were major reasons why I felt comfortable proceeding.

In the summer of 2025, after a period of inactivity on my part, Trichogenics' clinic manager, Nina Konstantaki, approached me with what was presented as a heavily discounted, supposedly limited-time off-season offer. This ultimately prompted me to book the procedure and arrange my flights.

At the time, I viewed the whole thing as a fairly exciting opportunity. In hindsight, I obviously see some of the circumstances very differently.

What Was Discussed Beforehand​

There was a lot of discussion about graft numbers.

At various points, I was given estimates ranging from approximately 2,500 grafts for a one-day procedure to 3,000 grafts over two days.

Other surgeons had independently estimated that substantially more than 1,700 grafts might be available from my scalp donor area.

I did not want another aggressive extraction session that would further damage my donor area, especially given that this was already my second transplant.

I therefore explicitly agreed with the principle of conservative harvesting.

However, I also specifically negotiated the use of beard grafts because I have a relatively strong beard and a limited scalp donor supply.

The expectation communicated to me was approximately up to 2,500 grafts, including beard grafts.

My understanding was also that Dr. Chris would play a meaningful role in the procedure rather than merely appearing for a brief review.

That distinction became important later.

Pre-OP picture taken a couple of weeks before the procedure

Pre-OP picture taken a couple of weeks before the procedure

Pre-OP picture taken a couple of weeks before the procedure

Pre-OP picture taken a couple of weeks before the procedure

Pre-OP picture taken at the clinic. Note how the hair is going forward.

Pre-OP picture taken at the clinic. Note how the hair is going forward.

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What Actually Happened​

The procedure was performed primarily by Dr. Despoina Kodoyiani.

She was assisted remotely by Trichogenics' founder and Chief Surgeon, Dr. Eric Peretz, who provided guidance throughout the procedure. During the planning process, Dr. Eric instructed her to stop harvesting scalp grafts at approximately 1,200.

The nursing team also included at least one nurse employed at Dr. Chris's own clinic.

Dr. Chris was present at the clinic only briefly. He examined me, reviewed the plan, returned towards the end of the extraction phase, and appeared again after the procedure had been completed. However, he did not perform the bulk of the surgery.

This was particularly disappointing because, based on what had been communicated to me and confirmed by clinic manager Nina Konstantaki shortly before surgery, I understood that Dr. Chris would not only supervise the procedure but also work alongside Dr. Despoina.

That was not what happened.

The final numbers were:

• Scalp grafts: 1,423
• Beard grafts: 308
• Total: 1,731 grafts

The final number was therefore substantially below the figures I had previously understood to be realistic.

I do not believe graft count alone determines whether a transplant is successful. I specifically wanted to preserve my donor area rather than chase an arbitrary number.

However, if the clinic ultimately decides to take an extremely conservative approach and stop at around 1,200 scalp grafts, I believe that needs to be communicated very clearly beforehand, especially when previous discussions have involved considerably higher numbers.

Donor Harvesting​

The clinic used a punch described as 0.85 mm and a Marathon micromotor.

I specifically asked about the Trivellini Mamba because Trichogenics advertises it as the extraction device used in every case.

I was later told that the Trivellini Mamba was generally reserved for more complicated extractions and that, since my grafts were easy to extract, the team had decided not to use it.

On its own, I do not necessarily consider that a problem.

What concerned me was the discrepancy between what is advertised and what was actually used in my case.

The extraction strategy was extremely conservative and involved a considerable amount of cherry-picking.

Harvesting also took place in the temple area immediately in front of the ears, extending towards the face. I have personal concerns about this approach. It creates additional FUE extraction scars in a cosmetically sensitive area, and hair from this region is generally considered less DHT-resistant than conventional scalp donor hair.

If temple hair is going to be used as donor hair, I believe there should be a particularly clear justification for why those grafts are preferable to other available donor options.

Ultimately, I appreciated the intention to preserve donor homogeneity. However, I also questioned whether my available donor supply had been assessed and utilised as effectively as possible.

The occipital donor area was largely excluded because it had been heavily scarred by my previous transplant, making extraction more difficult. This obviously reduced the number of grafts available. The occipital region is also an area where relatively robust grafts are typically found, potentially providing a stronger visual effect when used appropriately.

This is one area where I wonder whether a more suitable extraction device, such as the Trivellini Mamba, might have made harvesting from difficult areas easier or faster. I obviously cannot say retrospectively that it would have changed the outcome, but it is something I would have liked to discuss more thoroughly.

Only 308 beard grafts were harvested, despite my having a relatively strong, previously untouched beard and specifically requesting that it be used as a donor area.

I saw Dr. Despoina in tears while speaking to Dr. Eric on the phone after most of the extractions had been completed.

Post-OP picture. Note how much of the occipital donor area was simply excluded due to scarring and overharvesting rather than trying to approach it with the appropriate means.

Extraction included the temples near the face

Extraction included the temples near the face

The micromotor used for extraction - Not a Trivellini Mamba device

The Trivellini Mamba advertised on the clinic website.

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The Graft-Holding Solution​

Another detail that concerned me was the graft storage solution.

The preoperative advertising and communications referred to HypoThermosol.

According to Dr. Despoina, however, my grafts were actually stored in saline solution.

Again, I am not claiming that saline storage necessarily caused the poor result.

However, when a clinic advertises a particular graft-holding protocol but uses a different solution in practice, I believe it is reasonable for the patient to ask why.

In retrospect, this became particularly relevant because graft survival subsequently became such a major concern.

The Anaesthesia Problem​

This was probably the most uncomfortable part of the surgery.

During implantation, particularly in the frontal area, I repeatedly experienced significant pain.

At certain stages, I had to ask for additional anaesthetic injections roughly every couple of minutes.

I could feel the CHOI implanter entering my scalp to a degree that was extremely uncomfortable. It felt almost as though someone were pulling my hair as hard as they possibly could.

I was initially told that a substantial amount of anaesthetic had already been used on my beard and that my "vessels are thirsty."

Eventually, after I insisted on receiving additional anaesthetic, the situation improved considerably, and implantation became mostly painless again.

The explanation I later received from Dr. Eric was that previously transplanted tissue can contain fibrosis and scar tissue, which may make local anaesthesia more difficult.

He also told me that a periorbital nerve block could potentially be considered in difficult cases, but that this would only be performed when he or Dr. Asi was personally present.

That left me wondering:

Could a different regional anaesthesia approach have been considered earlier, particularly given that the recipient area had previously been transplanted and scarred? And why wasn't Dr. Chris called in to perform a nerve block?

I obviously understand that nerve blocks carry their own risks and are not necessarily appropriate for every patient. I am not claiming that one should have been performed.

However, the fact that the anaesthesia problem was already apparent during the procedure and was only adequately resolved after repeated requests for additional anaesthetic remains concerning to me.

There is another issue I have been wondering about since the surgery.

The local anaesthetic used contained epinephrine (adrenaline), which is commonly used in hair transplantation for its vasoconstrictive effect and to reduce bleeding. I am not medically qualified to conclude that the additional anaesthetic affected graft survival, and I am not claiming that it did.

However, given the combination of prolonged implantation, difficulty anaesthetising scarred tissue, and the subsequently apparent poor graft survival, I would like to understand whether the anaesthetic strategy and resulting vasoconstriction could theoretically have played any role in the outcome.

I would expect the clinic to be able to address this question from a medical perspective rather than leave it unexplained.

The Recipient Area​

The surgical report shows that a substantial proportion of the grafts were allocated to the existing hairline.

I was surprised by this because my main concern was the lack of density behind the hairline.

The left side was particularly problematic for me, and I had explicitly explained that my previous transplant had produced poorer growth in that area.

Nevertheless, the implantation pattern appears relatively symmetrical and somewhat standardised. The placement does not seem to reflect the asymmetry I had experienced following my first transplant.

After the main implantation phase had been completed, Dr. Chris returned and apparently identified an issue with the hairline.

He removed five grafts that Dr. Despoina had previously implanted and repositioned them himself.

He joked that he was not doing it for me but for himself because he was a perfectionist.

At the time, I found this interesting and appreciated that he cared enough to make the correction.

In hindsight, however, it raises an uncomfortable question:

Why was this issue only addressed after the main implantation had already been completed?

More importantly, why wasn't the surgeon who was supposed to be leading the procedure involved throughout the critical implantation phase, particularly when the clinic's own wording indicated that he would "design and execute your hairline"?

Post-OP picture. Note the focus of the graft distribution on the hairline.

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And Then There's the Result...​

Ultimately, this is what matters most.

I have now reached the 12-month postoperative mark.

Throughout the recovery period, I sent regular progress pictures to Trichogenics, including monthly updates.

Unfortunately, I cannot see any meaningful cosmetic improvement compared with my preoperative situation.

The left side of the treated area remains visibly see-through under normal everyday conditions.

Despite receiving a substantial proportion of the transplanted grafts, the existing hairline does not appear noticeably denser to me.

According to Dr. Eric, the apparent graft survival is considerably worse than expected.

Upon his referral, I subsequently had my scalp examined by a dermatologist and underwent a biopsy.

The only diagnosis was androgenetic alopecia.

I forwarded the medical findings to Dr. Eric.

Most importantly, when I asked what might have caused the apparent failure, Dr. Eric was unable to identify a specific procedural cause.

That is obviously difficult for me to accept.

If no cause has been identified, there is also no convincing explanation for why I should expect a repeat procedure to produce a better result.

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My Biggest Issue Isn't Simply "Poor Growth"​

If this were simply a case of a transplant producing less growth than hoped, I could probably accept that.

What concerns me is the combination of several factors:

1. Dr. Chris's level of involvement did not match what I understood had been agreed.
2. The final graft count was substantially below the numbers discussed beforehand.
3. The use of beard grafts did not provide the additional coverage I had expected.
4. Temple grafts were harvested, which raises concerns for me from both cosmetic and medical perspectives.
5. The occipital area was largely excluded as a donor area.
6. The advertised surgical AI method was not used.
7. The advertised Trivellini Mamba extraction device was not used.
8. The advertised HypoThermosol graft-holding solution was not used, according to Dr. Despoina.
9. Implantation involved significant pain because of difficulties with anaesthesia.
10. The recipient area had previously been transplanted and scarred, yet the anaesthesia problem was not adequately resolved until relatively late in the implantation phase.
11. A relatively large proportion of the grafts went into the existing hairline rather than the areas where I felt density was most lacking.
12. Dr. Chris identified and corrected a hairline issue only after the main implantation had been completed.
13. After 12 months, I can see essentially no cosmetic improvement.
14. No convincing medical or procedural explanation for the apparently poor graft survival has been identified.

Any individual point might be explainable.

Taken together, however, I find the overall experience very disappointing.

Refund Request​

I have therefore formally requested a full refund from Trichogenics.

At this point, I do not believe a repeat procedure is an appropriate solution.

There are several reasons for this.

First, in my view, the original expectations regarding the lead surgeon's involvement were not met.

Second, I have not received a convincing explanation for why the first procedure appears to have failed.

Third, without understanding the cause, there is no reliable basis for assuming that another procedure would succeed.

Fourth, Dr. Chris has since left Trichogenics and is therefore no longer someone I can simply ask to perform the next surgery. This is particularly relevant because my understanding of his involvement was one of the reasons I chose the clinic in the first place.

Finally, my donor resources are finite.

I have already undergone close to 6,000 FUE extractions in total. Another unsuccessful procedure could make my situation substantially worse.

Final Graft Breakdown​

Scalp​

• Singles: 89 grafts / 89 hairs
• Doubles: 1,047 grafts / 2,094 hairs
• Triples: 200 grafts / 600 hairs
• Quadruples: 11 grafts / 44 hairs
• Quintuples: 1 graft / 5 hairs
• Additional grafts: 75 grafts / approximately 157 hairs

Total scalp: 1,423 grafts / approximately 2,989 hairs

Hair-per-graft (HPG) ratio: approximately 2.1

Beard​

• Singles: 220 grafts / 220 hairs
• Doubles: 88 grafts / 176 hairs

Total beard: 308 grafts / 396 hairs

Grand Total​

1,731 grafts / approximately 3,385 hairs

Where I Stand Now​

I have now had close to 6,000 FUE grafts transplanted in total.

I estimate that I may have roughly 2,000 scalp grafts remaining, in addition to a reasonably strong beard and some usable chest hair.

I still need to address my crown eventually, but after this experience, I am obviously much more cautious about undergoing another surgery.

I am currently looking into surgeons with extensive experience in body hair transplantation (BHT) and donor management.

My preference would be to use as few additional scalp grafts as possible, supplementing them with body hair where appropriate, rather than continuing to harvest aggressively from what remains of my scalp donor area.

In the longer term, scalp micropigmentation (SMP) may also form part of the solution.

To Be Fair: Not Everything Was Bad​

I want to make this clear because I do not want this to read like an emotional hit piece.

My initial experience with Trichogenics was actually quite positive in terms of communication and professionalism.

The staff were generally friendly.

Communication was proactive and professional.

Postoperative monitoring was thorough.

Dr. Eric remained in contact with me and reviewed my progress pictures.

I also appreciated the intention to preserve my remaining donor supply rather than simply maximise the graft count.

The clinic itself was modern, and the overall organisation was generally good.

So this is not a case of me claiming that everything about Trichogenics was terrible.

My criticism is much more specific:

I believe there were substantial discrepancies between what I understood I was booking, how the procedure was actually carried out, and the result that was ultimately achieved.

And after 12 months, the most important fact remains that I cannot see any meaningful cosmetic improvement.

Bottom Line​

A hair transplant ultimately has to be judged by its results.

I went into this procedure hoping to address the shortcomings of my first transplant while preserving what remained of my donor supply.

Instead, I now have fewer donor resources, no meaningful visible improvement after 12 months, and no convincing explanation for the apparent graft failure.

That is why I have requested a full refund rather than another surgery.

I would be interested in hearing from people who have had similar experiences with poor graft survival after a second transplant, particularly in cases where the clinic itself was unable to identify a clear reason for the failure.

I would also particularly welcome input from experienced surgeons and patients on the following questions:

• Could the anaesthesia difficulties described above plausibly have affected implantation or graft survival?
• Does harvesting facial or temple grafts make sense in a case like mine?
• Do the graft numbers and their distribution seem reasonable given the stated objectives?
• Would attempting another procedure without first identifying a cause for the apparent failure make sense?

Please keep the discussion focused on the medical and surgical aspects rather than speculation about individual staff members.